David Kopacz, MD
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Collaborative Poetry Writing: Reaching Through Trauma & Psychosis to Connect with the Whole Person

Poster presentation, American Holistic Medical Association conference, Minneapolis, Minnesota, US

Kopacz, D. | September 18, 2014

Abstract: Developing trust and rapport with clients with both a history of psychosis and childhood trauma can be extremely challenging. This presentation examines the use of collaborative poetry writing in which clinician and client engage in a fun and creative shared task. This requires an egalitarian mindset that is not reductive, but is rather expansive, intuitive and creative. The result was increased connection through enhanced rapport and trust, the opportunity for client and clinician to come to know each other in a genuine and authentic way, and subsequent improved compliance with anti-psychotic medication.

Background: Clients with a history of childhood trauma and adulthood psychosis are limited in their ability to enter into a collaborative therapeutic relationship. Trauma leads to distrust of emotions and interpersonal relationships. Psychosis interferes with a person’s experience of themselves and their environment. Clients who have had coercive treatment under the mental health act and frequent police holds have even more reason to distrust clinicians. Even when biomedical treatment might be efficacious, clients have difficulty maintaining a therapeutic relationship and accepting treatment.

Methods: In a recovery-oriented, psychiatric rehabilitation setting the author developed a style of interaction based on collaborative poetry writing. This was done by writing down everything the client said in a verse structure. Interventions were poetic, existential and spiritual, rather than clinical, and focused on keeping the flow of the poem going, challenging fixed beliefs through introducing poetic paradox and encouraging growth and understanding. The resulting poem was then typed up by the author, a copy given to the client and it was reviewed together. The client had the option of publishing the work in the periodic client journal (with pay of $5 per page) which was distributed to all clients and staff.

Case Report: J, a 30 year old Maori man, had a history of childhood trauma and neglect, disrupted attachment, a mother with a psychotic disorder who had multiple hospitalizations leading to unstable living environments with numerous caretakers and foster families. Substance abuse began as a pre-teen. Schooling was disrupted. A cycle of homelessness and heavy binge use of substances followed, including solvents, marijuana, alcohol, and other drugs. A pattern of involuntary hospitalizations and over 70 legal charges led to admission to Buchanan Rehabilitation Centre, a 40 bed open residential unit in Auckland, New Zealand. J frequently refused medication, saying that he was not psychotic. He would fluctuate in his ability to engage and connect with staff, with cycles of increasing substance use and increasingly inappropriate and hazardous behavior, leading to re-hospitalization. He frequently would complain that doctors never listened to him and just pumped him full of drugs. At these times there was no reasoning with him and no possibility of engagement. Out of frustration of the recurring cycle, one day the author tired of the cycle of presenting logical arguments that went nowhere. At that point, the author simply began to write down, verbatim, everything J said, sometimes reading it back to him. With a sense of fun, the author then began to rhyme or add new elements to the discussion (the author is a poet and artist as well as psychiatrist). J, who generally had a good sense of humor, engaged in a back and forth banter. Rather than trying to be “therapeutic” the author worked with the material that emerged in a poetic way, but also with a sense of increasing mental flexibility and challenging overly rigid statements through humor or gentle shifts. Through this intervention/human connection J admitted for the first time that he actually had psychosis and began to take medication more regularly. The shift from a mind-set of medicating symptoms to validating J’s experience and being with J enabled him to trust more and accept treatment. (J gave permission to use his work at professional conferences).

Background of this poem: J approached the author in the hallway, saying with a characteristic cheekiness, but also a sense of urgency, “Dr. Dave, I have something in my eye.” Taking a quick look as I hurried to wherever I was going, I told him I didn’t see anything and we could get him seen by the GP later that day if it still bothered him. Later that day, J sought me out in my office and the following excerpted poem came to be. (I have chosen, as it is a collaborative effort, to not highlight the distinction between which of us is speaking, although it is often obvious).

The Poem:

Your Eyes have the Look of a Killer
Killers don’t say much
I better not look at your eyes too long
What’s in your eye?
Awwww…You ever feel like the world is spinning too fast?
Well, I heard a voice once, that maybe it stops
And you stop with it, and there’s a cross of energy
And you get caught up in it
In the future and the past, like a Void
Yeah, a Void…It’s almost like I need to remember something…
If I can remember something, then I know where to start
It’s just what do I remember?
It’s almost like I’m losing something
I need to find something
How am I supposed to fit into society?
How much has the Mental Health System really changed me?
In some ways, it hasn’t…
You guys have always been chasing, chasing me
I haven’t had time to relax…to remember
It’s almost like you put me to sleep
And didn’t help me find out what’s
In my eye.
Is what’s in your eye something only you can see or can I see it, too?
Ohh, you can see it or I can see…
I guess we’ve got to both see it
Let’s look for it…
It might trigger something off though
I might end up hurting someone…
Somebody’s already hurting
How do you know that? By yelling and screaming?
Sometimes pain is just obvious
No, it’s not.
You guys don’t understand,
Doctors don’t
You all just think you need to be put down
It’s not until I come off the drugs
How do I get rid of all that drug-induced shit?!?
Do I have to turn to Religion?
I was looking for something…
Looking for something with your Eye?
Yeah, as you do when you sit in class and things get too much
It’s like you float off, like, a break
Your eyes stare out and you see weird stuff
Like leaning your head against the bus window…
I thought about building boats…
You see weird things if you stay on a boat too long
It starts triggering things in your head
Looking back, you start realizing things
Realizing your Life is Shit!
Why did it turn out this way?
Why did I do those things?
Why did I hang out with those gangsters as role models?
Those dudes are fucking idiots
I don’t ever want to go to jail again…
If I don’t find something soon
I’ll be on the streets sniffing glue
With my flea bag mates
[he holds up a small globe from my office
he has been fiddling with while we talk,
attaching paper clips to it]
Look what I’ve done to your world!
You are not going to yell and scream at me?
What have you done to my world?
Wait…hang on a second….
What have you done to OUR world?
I got lost in it…
Some would say that’s the
Purpose of the world.
No, its not, you need Direction
Without Direction you get into trouble
That’s from personal experience!
This is all going to sound stupid freaky psychotic
I don’t think so, I think
It sounds philosophical,
Spiritual and existential
What’s “existential” mean?
That’s a strange word,
Is that what’s outside yourself?
Because “in-istential” is what’s inside yourself.
What if what’s inside yourself is not in-essential
But Essential!
Have you ever seen your face in someone else’s face?
Have you ever lived in a Mental Health Unit and dreamed of the
Streets cold and stealing?
What happened with your eye after all that?
I don’t know.
It’s just that I might not be able to cope with my eye like that
For so long
I might just take a long holiday inside my head
It’s too overwhelming
If I get too irritated I might end up killing
We can help you look in your eye
It’s hard to see your own eye with your own eye
Maybe you need to trust someone else to
Look in it for you
Maybe it will inspire me.
I got all day, to think
If I figure it out I’ll come tell you

Conclusion: For clients who are difficult to reach due to psychosis and trauma, the use of collaborative poetry writing may be a useful technique that builds genuine engagement and human connection. Elements of this technique include: a focus on poetry and meaning rather than on symptoms; the collaborative nature of working together on a creative project; an open and accepting attitude toward the client’s inner experience (writing down spoken words without putting in a “clinical” framework); the rhythmic structure of verse helping to structure chaotic thought processes; the use of poetic, existential and spiritual paradox to allow the client to challenge their own thinking; and creating a sense of play. Rather than forcing the client into the world of the clinician, or the clinician becoming lost in the client’s world, together, through collaboration, the client and clinician create a “bridge” to a shared world (see Patte Randal’s Re-covery Model). This work was done at Buchanan Rehabilitation Centre, Auckland District Health Board, New Zealand.

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